Average Volume Assured Pressure Support

Transcription

1 Ventilation Average Volume Assured Pressure Support

2 How to reach us Asia Europe, Middle East, Africa Latin America North America (toll free, US only) Philips Respironics 1010 Murry Ridge Lane Murrysville, PA USA Customer Service Philips Respironics Asia Pacific Philips Respironics Australia +61 (2) (toll free, Australia only) Philips Respironics Deutschland Philips Respironics France Philips Respironics Italy Philips Respironics Sweden Philips Respironics Switzerland Philips Respironics United Kingdom Koninklijke Philips N.V. All rights are reserved. Philips Respironics, Synchrony, BiPAP, Auto-TRAK are trademarks of Koninklijke Philips N.V. and its affiliates. All rights are reserved. Philips Healthcare reserves the right to make changes in specifications and/or to discontinue any product at any time without notice or obligation and will not be liable for any consequences resulting from the use of this publication. Broudy RP 5/22/15 MCI PN

3 Clinical reference Auto-TRAK algorithm Performance Characteristics of 10 Home Mechanical Ventilators in Pressure-Support Mode Chest 2005, Battisti et al Noninvasive Ventilator Triggering in Chronic Obstructive Pulmonary Disease AJRCCM 2001, Stell et al Performance Characteristics of Bilevel Pressure Ventilators Chest 1997, Bunburaphong et al AVAPS support function Average volume assured pressure support in obesity hypoventilation: a randomized cross-over trial Chest 2006, Storre et al Volume targeted versus pressure support non-invasive ventilation in patients with super obesity and chronic respiratory failure: a randomised controlled trial Thorax 2012, Patrick Brian Murphy et al AVAPS, a unique clinically proven technology For patients with Obesity Hypoventilation Syndrome The addition of AVAPS to BPV-S/T provides beneficial physiologic improvements, resulting in a more efficient decrease of PtcCO 2 compared to BPV-S/T therapy alone. Average Volume Assured Pressure Support in Obesity Hypoventilation: a Randomized Cross-Over Trial. Storre, et al. Chest For patients with chest deformities After switching to BiPAP-AVAPS therapy, the results included an increase in average oxygen saturation, a reduction of pco 2 levels and an improved acceptance of therapy compared to previously used ventilation methods. Average Volume Assured Pressure Support (AVAPS) for Pressure-Controlled Ventilation (BiPAP Therapy). Kerl, et al. Poster presented at the German National Home Mechanical Congress, For patients with hypercapnic COPD AVAPS mask ventilation has similar efficacy and produces better subjective effects on sleep as compared with PS in COPD patients with chronic hypercapnia. A pilot study on efficacy of nocturnal AVAPS mask ventilation in patients with hypercapnic COPD. Crisafulli, et al. Poster presented at the ATS congress, 2008.

4 Estimation of the exhaled tidal volume (Vte) Original baseline Flow adjusted for additional leak New baseline Digital Auto-TRAK algorithm combined with the BiPAP system is able to quickly identify the leak by comparing the original baseline flow to the new baseline flow. Differences are recognized as leaks, and adjusted for, quickly. Auto-TRAK algorithm estimates patient flow to provide: Automatic triggers: sensitivity remains optimal even with a change in leaks and patient s respiratory mechanics An estimation of exhaled patient tidal volume (Vte) for ventilation monitoring and for AVAPS. Based on Auto-TRAK advanced technology, AVAPS ensures a close monitoring of Vte and adjusts IPAP to maintain a true averaged patient tidal volume. The right pressure at the right time for more patient comfort and more efficient ventilation.

5 AVAPS suggested settings AVAPS Settings 1. Set the Target Tidal Volume: To 8ml/kg of the ideal weight and adjust depending on patient pathology 2. Set IPAP Limits: and IPAP max = 25 to 50 cmh 2 O depending on patient condition and maximum pressure available on the machine IPAP min = EPAP + 4 cmh 2 O depending on patient condition Check patient arterial blood gases (PaCO 2 and PaO 2 ) and oxygen saturation (SpO 2 ) * Conversion table to set the target tidal volume in relation to the ideal weight: Height Calculated ideal Target Vte Target Vte weight (if BMI = 23) if 8 ml/kg if 10 ml/kg 1.50 m 52.0 kg 410 ml 520 ml 1.55 m 55.0 kg 440 ml 550 ml 1.60 m 59.0 kg 470 ml 590 ml 1.65 m 62.5 kg 500 ml 620 ml 1.70 m 66.5 kg 530 ml 660 ml 1.75 m 70.5 kg 560 ml 700 ml 1.80 m 74.5 kg 600 ml 740 ml 1.85 m 78.5 kg 630 ml 780 ml 1.90 m 83.0 kg 660 ml 830 ml Above data have been calculated with an ideal Body Mass Index of 23 kg/m 2 (BMI=weight/height 2 ) Die obigen Daten wurden auf Basis eines idealen Body-Mass-Index von 23 kg/m 2 (BMI = Gewicht/Größe 2 ) berechnet.

6 What is AVAPS? Average volume assured pressure support (AVAPS) is a support function that can be activated within our S, S/T, PC and T pressure modes. It automatically adapts pressure support to patient needs to guarantee an average tidal volume. Based on the auto-trak algorithm IPAP max. performance, the patient s tidal volume is estimated at each breath IPAP and compared with the target tidal IPAP min. volume. Inspiratory pressure increases or decreases from breath to breath to ensure the preset tidal volume. Target volume Inspiratory pressure smoothly Patient changes (<1 cmh 2 O/min) so as not to volume affect patient comfort, and to prevent any potential patient- ventilator disynchronization. In case the patient tidal volume is far from the set target Vt, an accelarating factor will allow the inspiratory pressure to change faster by up to 3 cmh 2 O/min. Which patients? Obese hypoventilation patients: To compensate for changes in body position; averaged tidal volume ensured COPD patients: To achieve a combination of ventilation comfort and efficiency with no compromise. Get both benefits by applying the right pressure at the right time. Restrictive patients: To provide the comfort and leak compensation of a pressure mode, and the safety of a guaranteed volume Which benefits? Make titration process easier, no IPAP adjustment needed Follow disease progression as patient s ventilatory needs change Improve patient s ventilation efficacy and comfort Increase safety by guaranteeing an averaged tidal volume